Practice Improvement using Virtual Online Training

Innovative Features

Script Concordance Tests

Pivot SCT

Multiple-choice question (MCQ) tests are flawed. A major disadvantage in using MCQ tests is that they assess the learner's ability to perform the first-order function of fact-based recall. For this reason, we instead used Script Concordance Test (SCT) questions to measure the learner's higher-order ability to perform clinical reasoning within realistically, ill-defined scenarios. We are the first computer-based simulation product to incorporate Script Concordance Test (SCT) questions into the patient cases. SCT questions can teach areas of Medicine which are not clearly delineated in black and white, because the "answer key" is compromised of responses by a team of clinical experts. Expectedly, there will be some variability in their answers. Thus, partial credit is given to learner responses where a few experts also agreed with them. (Lubarsky S, Dory V, Duggan P, Gagnon R, Charlin B. Script concordance testing: From theory to practice: AMEE Guide No. 75. Med Teach. 2013;35(3):184-93. PMID: 23360487.)

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Differential Diagnosis Slider

Pivot DDX

When trying to diagnose an unknown condition, expert clinicians dynamically and constantly adjust their pre-test probabilities based on the patient's symptoms, signs, or diagnostic tests. In an effort to cognitively force and visually guide users to apply similar clinical reasoning principles, the Differential Diagnosis slider has been incorporated into some of the cases. With each key clue discovery, users adjust their pre-test probabilities for a broad list of diagnoses. This mapping process is an innovative approach to measure clinical reasoning on an individual level and consequently provide educators objective data to help target teaching.

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Gamification of Medical Education

"Game design isn’t just a technological craft. It’s a twenty-first-century way of thinking and leading. And gameplay isn’t just a pastime. It’s a twenty-first-century way of working together to accomplish real change."

Pivot Gamification

The "gamification" of medical education has garnered much worldwide attention, because of its potential to enhance learning, engagement, and learning for today's millenial learners. The foundation of the PIVOT cases consequently was built using gamification principles.

  1. The cases are generally divided into a two-staged game. Only after successfully accomplishing the task of Stage 1 can you unlock Stage 2. More specifically, users are required to collect a set of Key Clues which help them make the diagnosis in the patient. Stage 2 allows users to view and interpret the patient's laboratory tests.
  2. A point system allows users to determine how they are performing on the cases. Points are awarded based on their answers on the Script Concordance Questions, distributed throughout the cases. In the future, points will be detracted for performing potentially harmful actions or ordering unnecessary tests.

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High-Resolution Patient Photos and Videos

Pivot Multimedia

In comparison to many commercially available computer-based simulation platforms, the PIVOT platform is far superior because of its incorporation of real, high-resolution patient photos and videos. These images not only show just the abnormal findings but also normal findings. This provides an added degree of immersive realism, which helps users to imagine themselves actually in the clinic, urgent care, or emergency department taking care of the patient. In fact, the patients who were photographed and videotaped left inspirational video messages to the learners at the end of the cases.

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Expert Debriefing Section

Pivot Debrief

Computer-based simulation platforms are in many ways similar to high-fidelity simulation mannequins. The literature has proven that the immediate post-case debriefing component is a critical part in solidifying the learner's retention of new knowledge and your educational objectives. In the PIVOT cases, a debriefing section is provided by physician content experts on the topic. Furthermore, keeping in mind the Zone of Proximal Development concept where learners should ideally be taught at a level just slightly above their current knowledge level, an optional advanced debriefing section is also available to teach the more senior-level learner.

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Compatibility for iPad and tablets

Pivot iPad

This platform was programmed using Ruby on Rails because of its compatibility and mobile responsiveness on tablet devices such as the iPad and iPad Mini. This contrasts many commercial products which were programmed using the soon-to-be-outdated, iOS-incompatible Adobe Flash software.

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